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For readers who subscribe to Bacon's contention that some books are to be tasted and a few chewed and digeested, and prefer the latter kind, Virginia Lewis* Russell Smith, Romantic Realist willprovide the perfect fare. The latest of many distinguished publications by the University of Pittsburgh Press, Miss Lewis' interpretation of the life and work of this nineteenth century painter to whom both Pittsburgh and Philadelphia may lay claim is a 350 page volume studded from Introduction to Selected Bibliography with rich material to intrigue professional and amateur historians and art enthusiasts alike.

tice has terminated in a selection that will tend to make us better acquainted with the nature and treatment of a disease the most alarming and fatal. The author arranges his facts and observations in the following order.
The essay commences with a history of apoplexy; proceeds to the anatomy of the disease, and observations on the morbid appearances. The second section treats of serous apoplexy: the third is occupied in detailing the means employed in the paroxysm: the fourth contains the cases and dissections of apoplexy and lethargy; to which is annexed a commentary on the cases. The volume concludes with a very proper appendage?an explanation of the five plates which elucidate the facts and principles of the preceding pages.
In endeavoring to present our readers with a view of the practical, and therefore valuable, part of this work? we shall not, however, adopt precisely this method, but shall first explain the causes of the two species of this disease, as laid down by Dr. Cheyne; give his description of the appearances that precede the attack, the symptoms in the paroxysm; and conclude with the method of treatment.
1 he real nature of apoptaxy, the causes of the symptoms, and their usually fatal termination, with the most probable mode of preventing or removing the disease, will be best ascertained by the examination of bodies post mortem. Of this our author has been fully convinced, and has therefore f f 2 taken 212 Critical Analysis. taken every opportunity of inquiring into the state of the brain, the organ directly affected in this disease \ the result of which he gives in what is denominated the Anatomy of Apoplexy. The state and general appearances of the parts contained within the cranium of those who are apoplectic,' ar&Jthus described: " In dividing the scalp, there is often a great flow of blood from theoccipetal and frontal veins. During the whole of the dissection, the venous blood flows from all parts of the head: first, from the superficial veins; and then, in a stream, from the sinuses; so that the quantity collected amounts to one or two pounds, or even more. " The flow of venous blood principally arises from the accumulation of this fluid on the right side of the heart. In the first instance it escapes the more easily, as the veins within the head are not furnished with valves; but it continues to flow after the brain has been taken out of the skull. It is from the turgescence of this part of the vascular system, that the skull-cap is forced up as soon as the section of the bone is complete. " The dura mater is sometimes thickened and bound to the cranium by the strongest adhesions; and I have seen the small branches of the arteries which supply this membrane, numerous and distinct. " The tunica arachnoides does not always preserve its transparency ; it is sometimes much thickened aud opake. The pia mater is sometimes remarkably vascular. The veins are turgid with dark blood; and in particular parts of the pia mater, nay, sometimes over its whole extent, there appears high arterial action; the whole surface acquires a bright vermillion tint, and between the minute and florid vessels, there are particles of scarlet extravasation; the membrane at these parts is bloodshot. There is often observed between the tunica arachnoides and pia mater, a serous effusion, which varies in appearance: in some bodies it is colorless; in others turbid, bloody, or even mixed with streaks of coagulable lymph. " The substance of the brain is often unusually firm, and, when cut into, the numerous points of blood show that the divided vessels are enlarged. It ought, however, to be mentioned, that, according to Portral, the substance of the brain is more condensed and heavy in aged persons than in early life. ' Chez les vieillards Je cerveau est proportionellemeut beaucoup plus dense et plus pesant qufe chez les enfans.' " The ventricles are often enlarged, and contain serous fluid in considerable quantity; and the communication between the ventricles is generally enlarged. " For the most part extravasated blood is found within the eranium; sometimes between the membranes; sometimes bursting the walls and floor of the ventricles, we find a great effusion of blood both in the substance of the brain and in the ventricles. Coagulated blood has been found iq, various parts of the cerebrum and cerebellum of the same subject; and it has also been found in the theea vertebrarum. 1 have never seen extravasated blood on the surface Dr. Cheyne on Apoplexy and Lethargy. 213 surface of the brain, which did not appear to have risen from a. rupture in its substance; but, in a case communicated to me by a friend, the blood seemed to have flowed from a number of the smaller arteries of the pia mater.
" When blood is extravasated into the substance of the brain, it is contained in a cavity, the walls of which are uneven and rugged; and in this irregular cavity the substance of the brain is generally so mixed with blood, that we cannot wash the blood away without earn ing along with it portions of medullary matter. " We do not always discover extravasation of blood, but we never fail to And remains of greatly increased action, and great congestion, in the arterial and venous systems of the brain.
" The membrane lining the ventricles generally exhibits appearances resembling those which are observed upon the pia mater of the surface of the brain. The plexus choroides is not uniform in its circumstances; it is often bloodless, when the ventricles contain serous fluid ; but it is also often florid; and not imfrequently there are a number of vesicles attached to it which contain fluid. " My dissections tend to confirm the observation, that blood is generally found extravasated in the hemisphere opposite to the side, of the body paralysed; and that, when paraplegia attends apoplexy, we may expect to find extravasation of blood about the base of the brain, or in the'tube of the spine. " It has been thought, that extravasation of blood is only to be found in the cerebrum. This opinion, however, is erroneous; I have observed extravasation in the cerebellum in three, if not in four, instances. " Upon dissection, cavities of a large size have been found in the substance of the brain of those who have survived an apoplectic stroke for some time, containing flakes of coagulated lymph, or of bloody-colored fluid, or of limped serum. These cavities have long been attributed to a rupture of the vessels in the original attack of apoplexy." In the brain of those who die of apoplexy, the most unvarying appearance is, an excited state of the minute arteries of that organ and its membranes ; next, an extravasation of blood, the consequence, probably, of the excitedstate of the vessels ; the turgescence of the venous system ; the enlargement of the ventricles, partial or general; and, lastly, the serous effusion, which i^ generally found in various parts of the brain. There are no morbid alterations in other parts of the system appearing to have any connection with the apoplectic state,* the liver excepted, in which fA i Critical Analysis, Dr. Cheyne often found that disorganization, which is thft well known effect of the abuse of wine and spirits. It does not clearly appear, however, that, in those instances where this character of disorganisation did occur, there had not been the abuse of wine and spirits; which might have been the exciting cause of the disease of the liver and of apoplexy. If observation shews that this state of the liver, resembling that produced by the abuse of wine and spirits, exists in cases of apoplexy, when that intemperance has not beer? practised, we will admit a diseased liver of this species, and the altered state of the brain, to have some reciprocal influence on each other. But, as long as intemperance in wine and spirits is as much an exciting cause of apoplexy in certain habits as of diseased liver, we may suppose them both to arise from that source, rather than admit tlie state of the liver to be indicatory of, or occasioned by, the peculiar disease of the brain.* v The * In another part of his Essay, p. 175, Dr. C. goes more particularly into the state of the liver, as connected with the apoplectic state; and, as it contains not only ingenious observation, but facts of considerable interest, we shall cite the passage in this note. .

"
In dissections after apoplexy, we shall seldom fail to find the liver much diseased; and the disease of the liver to be one which, apparently, had been of slow formation. A gentleman of very distinct observation informs me, that he has seen apoplexy fatal in 2-1 and 36 hours, to patients under ascites connected with diseased liver, in whom the absorbents, in consequence of mercury, had begun to act with great vigor. An interesting case of this nature is related in the 5th number of the Dublin Medical and Physical Essajs, by Dr. Mills. The patient, whose liver was hard and enlarged, had been afflicted with ascites and anasarca, but was relieved by the free exhibition of crystals of tartar; but, whilst full of the hope of perfect recovery, he was seized with symptoms of sanguine apoplexy, and was unexpectedly carried oft*." This certainly tends to show the influence of the liver upon the sensorium commune. But the observations of our author, on the influence of the hepatic system, do not stop here: in tetanus, in catalepsy, chorea, and epilepsy, and in all diseases of the brain and nervous system, he considers it to be an essential point to look to the condition of the liver. The following statement is too full of interest to be omitted.
" Perhaps, adds Dr. C., I am throwing a ray of light on the subject, when I state, on the authority of an accurate anatomist, Mr. Todd, that, in every dissection he has made after idiptism and mental derangement, and he has made upwards of four hundred, he has found the liver more or less diseased. He observes after insanity generally no great change of color, but the organ is more bulky, 4 with Dr. Cheyne on Apoplexy dnd Lethargy.

215
The Anatomy of Apoplexy, as delineated by Dr. Cheyne, is fully supported by his cases. In the 4th case, a coagulurn of blood, weighing one ounce and three drams, was found in the left lateral ventricle; and when it was removed, the plexus at the bottom of the ventricle was torn. In the 7th case, when the scalp was divided, there was a great flow of dark blood; and, during dissection, blood flowed from the divided veins to the quantity of two pounds. On the pia mater there were striking marks of inflammation ; it was marbled all over with deep red and purple patches of inflamed vessels, and streaks of extravasateu blood. Though the substance of the brain had no marks of inflammation in this case, and there was considerable serous effusion, there were many appearances of that state in various parts. The plexus choroides, and velum interpositum, were turgid, and red blood-vessels were in great number on those parts. On the base of the brain, and about the pons varolii, and on the celebellum, the appearance of inflamed vessels prevailed.
The 8th case presented a general turgescence and accumulation of blood in the head ; on opening the right lateral with a thicker edge, and always connected by preternatural adhesions, sometimes of great extent, to the peritoneum. " That the brain should be suddenly affected in consequence of its connection with the liver," is not more remarkable than that the liver should be suddenly disordered from affections of the brain.
Yet this test is an established observation. I am informed, by a gentleman who has occasion to dissect a great many bodies, that, in diseases of the brain, he never fails to find the liver diseased, either as a cause or a consequence. The same gentleman assures me, that the liver generally discovers marks of recent inflammation after fatal injuries of the head. Every surgeon knows abscess of the liver is a common effect of injuries of the brain. " Une femme, agee de SO ans, qui n'avoit jamais eu maladies, eprouva une grande contrariete, qui lui occasionna un acces de colere si violent, qu'en moins de quelques heures elle fut, prise d'un ictere general d'unjaune tres-force. Le vingtieme jour, il lui survint deux depots & l'avant-bras gauche. Le vingt-cinqui&me elle eu des vomissemens bilieux; et elle mourut en repetant, qu'elle ne pardonnait pas l'oflense qu'on lui avoit fait?<)bs. par M. L. V. T.
Amand. Bulletin des Sciences Medicates. Avril 1810.?I cite this as probably the most recent instance on record of an affection noticed by Riverius, the aurigo ab ira; and, if I mistake not, jaundice is related to have appeared as the effect of other passions." At a time when the distant sympathies of the animal system; and the reciprocal influences of organs remote from each other, are looked to with great solicitude, the hypothetical embarrassments connected with this solicitude may be much relieved by these facts. ventricle 216 Critical Ahalysis. ventricle a great quantity flowed out, and in its fore part a coagulum the size of an egg, or larger, was found, Ths^ Qth, 10th, and lJth, cases, presented similar appearances,. It appears very decidedly from the facts stated by Dr. Cheyne, that an accumulation of fluid in the brain or its ventricles, either blood or serum, is the immediate cause of the apoplectic paroxysm; and that in all instances, even where the accumulation has been serous, there were accompanying marks of turgescence in the blood-vessels, and appearances, greater or smaller, of inflammation.
Tobacco. Upon these he makes the following remarks: " Apoplexy, as appears by this enumeration of its chief causes, Is generally the effect of intemperance and improper indulgences.
Intoxication, which is entitled to stand the first in the list, may he considered in two points of view in relation to the disease: the habit forms the diathesis; the act is the occasional cause of apoplexy in a great variety of instances: nay, I believe, the daily use of wine and. spirits, even in what is considered a moderate quantity, ivill lead a. man of a certain age and constitution to apoplexy, as certainly as habitual intoxication, ivhich rather leads to mania, and, when excessive, to a state between phrensy and insanity. My own experience of apoplexy would have inclined me to a different arrangement. I should have placed gluttony?' grandes patinae et tuceta crassa,' next to drunkenness, and the use of tobacco higher in the scale. It has been observed, if 1 mistake not, by Cullen, that snuff-taking produces premature senility. The observation, I think, I have seen verified; and I am convinced that apoplexy is one of the evils in the train of that disgusting practice. Form and constitution, when unconnected with intemperance, I should have placed at the end of the list. It is well known that deep study, and despondence, in consequence of great misfortunes, have occasioned apoplexy." Having stated the remote and proximate causes of apoplexy, we shall proceed to a short detail of the phenomena produced by those causes: 1. As indicatory of the approach of the apoplectic paroxysm; and, ?. As descriptive of the paroxysm itself.
The appearances of the apoplectic paroxysm are so marked that few will misunderstand them ; however graphic, therefore, the description of Dr. Cheyne, and faithful to nature it is in the highest degree, we think it of more importance to dwejl on the symptoms that precede or mark the approach of the disease. These we consider to be of importance, because.
Dr. Cheyne on Apoplexy and Lethargy. Q17 because, by a due attention to them, the impending danger may often be obviated, and the patient rescued from the attack of a fatal malady. " Some of the appearances observed before the apoplectic fif, which are vulgarly thought to promise long life, are, in reality, the effects of disease. The fulness of the body is often attended with debility of the bronchial membrane, as evinced by wheezing, and frequent attacks of catarrh. There is a languor, which stimulating liquors confirm, although they relieve it while their immediate) effects last. There is an inactivity and muscular debility, which tew men advanced in life are willing to acknowledge. And, to the discerning observer, the ruddiness of the complexion often demonstrates Beside these predisponant and proximate causes of apoplexy, physicians of great reputation have supposed some atmospherical influence to have produced an epidemic constitution, productive of apoplexy. Thus Baglivi, Lancici, and Morgagni, explained the frequent occurrence of apoplexy in some years. In May 1721, and in 1741, the frequency of this disease was explained from the sudden recurrence of heat after cold. The great heat of 1808 seemed to be productive of apoplexy. Our countryman, Dr. Cole, whose treatise was published in logy, endeavors to make the great increase of apoplexy in His4 depend on the debility produced by the intense cold of 1683.
The predisponent and proximate causes acting to a certain degree, the apoplectic paroxysm is produced. But for a description of this we must refer to Dr. Cheyne's book.
The treatment of the disease during the paroxysm is confined to, ]. Blood-letting. 2. Emetics and purges; and, 3. External applications.^ All these Dr. C. examines with critical minuteness, more especially the first and second. Of blood-letting, he is the decided advocate. His opinion is founded on the state of brain in those who die apoplectic, and is ably supported. To do it justice, the whole section should be quoted. In deciding upon the propriety of bloodletting in the paroxysm, as the embarrassment of the practitioner arises principally from the notion that by it the serous species might be aggravated, or the probability of subsequent paralysis increased, it may not be useless or improper to give a summary of the experience of our author upon this important point. " I believe I speak within bounds," he observes, " when I sav, that I have attended fifty fatal cases of apoplexy, in which there was room for practice. Of these only one was a case of serous apoplexy, the rest, to every appearance, were sanguineous: the nature of many of these cases was demonstrated by subsequent dissection. Now, admitting this proportion, that there are fifty cases of sanguineous apoplexy, which require the physician's assistance, for one of serous, (and as some distinguished physicians have altogether denied the existence of serous apoplexy, it is probable that I have not overrated the proportion,) we may found an argument in favor of bleeding, which will not be easily overturned, upon the relative frequency of the two species of the disease." It appears, on the evidence produced by Dr. Cheyne, that what may truly be called serous apoplexy, is a disease of very unfrequent occurrence. He questions if the cases produced by Morgagni were more than three of the twenty that belong to serous apoplexy \ and even against them, as perfect specimens of that species ot the disease, much objection lies.
Dr. Cheyne on Apoplexy and Lethargy. 219 lies. The great object, however, though serous apoplex}' may be a rare disease, as it is admitted sometimes to have happened, is to distinguish between it and the sanguineous species. But here we are left in a state of incertitude. It would be inferred that pale, emaciated, and relaxed, persons, in advanced life, who have lived abstemiously or temperately, would be the subjects of serous apoplexy; but, when such persons have died apoplectic, the vessels of the braiu have been found gorged with blood, or there has been extravasation of that fluid. The learned pathologists Morgagni and Portal do not give an}' satisfactory information.
The conclusion then is, that, as we want diagnostic marks by which to distinguish the species, and as the cases in which accumulation of blood takes place in the brain are as fifty to one, (on the evidence of dissection,) we should abstract blood in all instances of the apoplectic paroxjTsm, as the safest alternative. To this Portal assents, when he recommends the same treatment in both species. This is, however, a point of too much importance to be hastily decided on"; we should be glad to see the question still further argued ; and also a more determined prophylactic system of treatment laid down.
The use of emetics and purges, especially the former, have excited professional controversies, which have explained little more than the unsettled opinions upon the nature and treatment of apoplexy, and the unphilosophical spirit which actuated the contending parties. Dr. Cheyne is decidedly against the use of emetics, and gives his reasons at large, lie examines and controverts the arguments of Pyrrho, as the}-appeared in this Journal in the controversy between Crowfoot and Langslow.
Upon external applications not much is said. Blistering the scalp, at least at the commencement of the paroxysm, is reprobated ; but the application of cold to the head is recommended, by sponging with water and vinegar, solution of muriate of ammonia, or iced water.
The connection between apoplexy and other diseases of the brain and nervous system, as catalepsis, extasis, cards, cataphora, lethargy, &c. appeared to Cullen to be so close, that lie reduced them to one genus, Apoplexia: and accordingly, in his Nosology, they appear but as species of that affection. The truth and propriety of this Dr. Cheyne denies; and argues very forcibly both on his own experience and observation, as well as from the statements and opinions of many other physicians, for the necessity, ir we attend to the phenomena of' these diseases as they appear in nature, of" Braking them distinct genera. The whole of tfrese observac g 2 tions C20 Critical Analysis. tions are well deserving attention, but we have already given so much space to this article, that we must refer our readers to the work itself, with an assurance that they will be recoinpenced for their trouble. We cannot refuse, however, to quote the following passage, as containing some facts in confirmation of a principle supported with much ingenuity by a physician of MontpeJlier. " The annals of medicine abound with instances of metastasis and comersion in the diseases of the skin. Thus the exanthematous eruptions, when suddenly repelled, are followed by hurried and oppressed respiration: tinea has ended in hydrocephalus, and erysipelas in lethargy, Several cases of this kind are annexed to Hoffman's Thesis de Affectibus Soporosis. One of them is the case of a corpulent and plethoric man, of fifty years of age, of a sanguine temperament and bad habit of body, who had an erysipelas with shivering and fever. On the third day of this disease he allowed an empiric to apply to the affected part an epithora of comfrey boiled in vinegar; immediately after which he fell into a deep sleep, from which there was no rousing him. He was let blood, glysters were administered, and nitro-camphorated powders given, and soon after the patient was roused from his sleep; but he, who had been of the most lively parts, and had possessed an incomparable memory, had his mind entirely destroyed. His memory had suffered so much, that he could not recollect any tiling which had happened to him. Every remedy was tried in vain. He remained several years in this deplorable state; during which his appetite continued unimpaired, and his body was duly nourished.
" When a patient, after a pleuritic attack, dies of carus, he is delirious before he sinks into stupor. This is also the course after ischuria. In some rare instances of coma after ischuria, it would appear as if the vessels of the brain assumed an action similar to the healthy action of the vessels of the kidney: fluid, with the color and smell of urine, having been observed in the ventricles of the brain. J'ai, reconnu l'odeur d'urine dans uue epanchment d'eau qui s'etoit fait dans les ventricles du cerveau d'une liomme mort d'une suppression d'urine. Portal.?And yet this is scarcely more extraordinary than the case of the girl whom I saw in 17S7-She vomited, at stated times, a fluid with all the sensible qualities of urine; the dis. charge by the urinary passage having long been suspended." Upon the extraordinary conversions, either in structure or functions of various parts of animal bodies, Dumas has a dissertation of considerable research, in which will be found manv facts similar to the above. We must here take leave of this valuable addition to practical medicine, written upon a class of diseases of the first importance, and in which the most prompt treatment is required. We confess to have risen from its perusal with standing the diseases of a country, that is, becoming acquainted with the vicissitudes of its seasons, and the apparent effects the changes produce on the animal fabric, was judiciously taken by Mr. Boyle. On this subject he says, " The vicissitudes of seasons, and the various modifications of atmospheric constitution, powerfully influence the character of diseases, and the appearance of certain epidemics, in this climate. Accurate meteorological observations, therefore, as well as the investigation of those circumstances, which properly constitute medical topography, present an interesting field of inquiry, and not only facilitate the investigation of the cause of diseases, but form a branch of knowledge essentially connected with their prevention, and method of cure.
" In remoter asjes, this subject received particular attention, and almost every page of the writings of Hippocrates inculcates the utility of this study,?which was considered, by that great man, not less essential to the physician, ,in order to enable him to predict approaching changes, and guard against their effects, thaii it was deemed necessaiy by the Mantuan poet, for the husbandman and mariner. " As far as regards the great revolutions of the year, and the periodical return of the seasons, a great uniformity obtains: and the observations of one year on this head, with but little variation, apply almost to every other. " On this depends the great uniformity of the diseases which usher in the different seasons. Those seasons, however, differ materially from each other; and a difference not less remarkable, and important in practice, characterises the diseases by which they are invariably 12& " Critical Analysis.
l>ly attended, and which, agreeably to those changes, undergo certain alterations of type, as well as of other important symptoms.
" The occurrence of the dry ant) rainy seasons may always, indeed, be expected with tolerable certainty, at the regular and accustomed periods. The diurnal vicissitudes, however, are very frequent, and, until the hot season has fairly set in, sudden changes of temperature are very common. " From the beginning of June, may be dated the commencement of the hot season; from which time, until the beginning of September, the temperature continues pretty steadily about the same standard, and, as observed in the shade at noon, usually ranges between 82? and 86? of Fahrenheit's scale. During this period, east or westerly winds for the most part prevail; rain seldom falls; and it frequently happens that the months of June, July, and August, pass away, even without a single shower. Of these, July is the hottest month, and the thermometer sometimes reaches the 89th degree; while the suffocating sirocco winds commonly continue until noon; after which hour a westerly breeze generally springs up. " About the latter end of May, inflammatory affections of the head begin to make their appearance; but they, as yet, are generally slight. In the month of June, however, and as the heat of the season advances, they become more frequent in their appearance, as well as more violeut in their symptoms. " About the beginning of September, the weather undergoes a very remarkable change, which is more particularly to be attended to, on account of the important influence it exerts as a cause of the disease which now succeeds. Together with a diminution of temperature, rains begin to fall, accompanied with thunder and high wiuds. About this tune, the thermometer falls to 76?, indicating a diminution of temperature, not less than 10 or 12 degrees. This change is sudden, and produces a very conspicuous effect on the nature of the prevailing disease. " The fevers still are of the inflammatory kind, but the affection of the head no longer forms so conspicuous a symptom; instead of which, they now manifest themselves under the form of phlegmasia! affecting other parts. " The showers however are but transient; the mercury in the thermometer again rises, but does not again attain so great a height; and the weather becomes dry and settled, until about the end of October, when heavy rains set in, accompanied with a considerable and permanent diminution of temperature, which puts a period to the violence and frequent occurrence of the epidemic. " During the winter and spring, pneumonia and acute rheumatism are the prevailing complaints; but those which prove most tedious and fatal are obstinate dysenteries and iutermittents; the common sequel of violent attacks of the autumnal fever, and dependent on chronie affections of the abdominal viscera.
" On the approach of autumn, the character of the fever, as has been already said, undergoes a considerable change; and, though this Mr. Robertson on Poisoning by Corrosive Subliviate. 223 this is effected by apparently slow gradations, one epidemic passing, as it were, imperceptibly into another, they not only differ essentially as to their exciting causes, but also in their origin, and seatthe febrile disease of summer arising from affections of the encepbalon, depending on inflammation and its consequences; while those of autumn are more particularly dependent on inflammatory affections of the stomach, and other abdominal viscera." The fever which makes the subject of this paper, being connected with, or depending on, an inflamed state of the. encephalon, or of the stomach or other abdominal viscera, according to the season of attack, blood-letting, and other evacuants, were alone to be depended on. With a view to obviate or to remove debility, as the disease assumed an intermittent form,-cinchona was sometimes employed: " but I feel myself warranted (says Mr. Boyle) to affirm, from the result of several cases in which this plan was adopted, in the fever now under consideration, that bark served only to exasperate the local disease, and to aggravate every symptom of the succeeding paroxysm." Mercury, especially in the form of the sub-muriate, the author found to be so effectual, that, he says, it is to be resorted to immediately, both externally and internally, as the most powerful remedy we possess in the treatment of this disease.
XL Case of singular Affection of the right Leg, which, on Extension of the Limb, excited agonizing Head-ache; by James Ramsey, M.D.?A young lady, eleven years old, with feverish symptoms, debility, and loss of appetite, constipated bowels, foul tongue, and offensive breath, had a singularly acute pain in the head, and flexor muscles of the right leg, whenever that limb was in the least extended. It was presumed that the cause of all the complaints was in the head, and indicating an approach to hydrocephalus. Leeches were applied to the temples, active purges were persisted in, with blistering, and digitalis. Under this management the disease soon gave way, and the patient was restored to perfect health.
XII ceeded diarrhoea and tenesmus, with the evacuation of a small quantity of bloody mucus, and extreme debility, which was followed by severe ptyalism. Sudorifics, opium, and nutritious diet, recovered him. The principal point in the case is the action of the poison on the first passages, though taken into the system by the cutaneous absorbents. A short time since, we related a similar instance of affection of the first passages, from the application of a nostrum to the arrriSj in which was a strong solution of hydrarg. murias. ' Xlir. Casetof Palsu mred by Tilitlution; with some Observations on the Effects of 7 itillalion on the Nervous System; by James Wardrop.?From the novelty of the remedy, the fortunate result, and the ingenuity of Mr. Wardrop's remarks, we are induced to give our readers the principal part of his detail. " A man twenty-three years of age, in the month of April, IS 10, when with the army in Portugal, was seized with a fever, which was at that time epidemic among the troops. In consequence of repeated attacks of t>ie disease, he remained for nearly twelve months in the different military hospitals of Coimbra, Lisbon, <ic. Besides what he described as the febrile disease, he had a severe affection of his head, for which he was bled profusely; and, when he returned to Britain, he had a complete paralytic affection of the left side. By living in the country, he regained a good deal of strength ; and he was able to move, though in a very small degree, the paralytic arm and hand. Soon after this, the complaint in his head returned with its former violence, but, by copious and repeated bleedings, the giddiness and stupor, which were the chief symptoms, were removed. The paralytic affection of the left side, during this attack, became more complete; and, although his general health improved, yet, in the beginning of August last, notwithstanding the most rigid antiphlogistic treatment, and a continued use of blisters and electricity to the affected side, the limb continued feeble, and his arm and hand perfectly useless. \ " When I saw him at this period, which was the middle of August last, eighteen months from the commencement of his illness, he had a marked halt in the left leg, and the left arm hung motionless, not having the power of even producing any sensible movement with any of his fingers. The arm, too, was considerably wasted; the hand (edematous, with occasional pains about his shoulder; his pulse a little full and frequent; his tongue furred, and a tendency to headache. After completely emptying his bowels by aloetic purgatives, and cupping him in the neck, by which treatment all the febrile symptoms, and those of determination of blood to the head, seemed to be removed, I began to try the effect of tilillation.
"The process which was employed to titillate was extremely simple. A person was directed to draw a feather gently over the surface of the skin on the palm of the hand, until it excited laughter; and I purposed that this should be done three or four times a-day.

" On
Mr. Wardrop on Palsy cured by Titillation. 22-5 " On trial, it was found that the desired effect could readily be produced. At first it was found that a considerable time was necessary to excite laughter; but, the more frequently the application was employed, the more quickly it was accomplished. He found, too, that the laughter was produced much more speedily when he was tickled by another person, than when he used the feather himself; and that it was most easily excited, by applying the feather to the part of the palm where it is marked by the flexion of the thumb. " The beneficial effects which the titillation produced on the paralytic arm, exceeded my most sanguine expectations. " After employing it a few days, he began to feel as if the limb were re-animated; a sensation which lasted a short time after each fit of laughter. This sensation was soon followed by a power to produce a sensible and voluntary motion of the fingers, whick daily increased; so that in about a month from the commencement of the use of the titillation, he could grasp his hand with a moderate firmness, and move, in like manner, the elbow and shoulder joints. After this period, the strength of the limb was rapidly regained; and in two months from the commencement of this treatment, I met him in the street carrying a bundle under the affected arm.
" The titillation was also used to the lower extremity of the affected side, the feather being applied to the sole of the foot, where it failed not to produce a speedy and great degree of laughter, " Besides the titillation, it ought to be mentioned, that I also advised him to rub the limbs with the dry hand, morning and evening; and this was done with a view not only of removing the cedematous swelling, but also of producing an additional excitement on the skin. 1 have seen the patient four months after the above treatment had been employed, when he remained perfectly well. I am aware that the event of any new mode of treatment, in an individual instance, cannot be sufficient to warrant any general conclusion. The case, however, seems to me to afford an interesting illustration of the influence which the functions of the skin have on the nervous system, and to open a channel for observation and experiment, ia various diseases of that system, which may lead to important improvements in their treatment. Under that impression, I have ventured to lay these remarks before the public, in their present form; and with the hopes that, by their early communication, the good effects of the practice may be established by the ample experience of others. " It may be remarked, before concluding these observations, that a good deal of discrimination must necessarily be employed in selecting cases where titillation is likely to prove beneficial, and in determining the extent in which it may be prudent to employ such a remedy. As long as the paralytic affection seems to depend on an increased quantity of blood in the encephalon, or to arise from any morbid alteration in the structure of the brain, or its coverings/ ail attempts by titillation, or other means, to recover the power of the paralytic nerves, must be fruitless, if not highly dangerous. Titillation appears to me to be applicable to those cases only where the primary affection is removed, and where the palsy, which was merely one of its symptoms, alone remains. How far titillation may have effect in alleviating the excruciating pain of tic doulourtiix, sciatica^ and some other affections which seem chiefly confined to nerves, experience can alone determine. Titillation, when employed in the treatment of diseases, must, like other powerful remedies,, be at first used with caution; and we are enabled to vary the extent of itseffects, from tickling to laughter, or even convulsion.
" Every one knows, from personal experience,' the two first degrees of its effects. There are; I believe, many instances of its having produced convulsions, and I have heard of one ease where it proved fatal. In all probability, the effect3 of titillation, as a remedy, should be confined to the excitement of laughter, which in old or obstinate cases may be excited even to an immoderate degree. " It is, perhaps, difficult to determine how fer titillation acts directly on the affected nerves, or indirectly through the medium of the brain; the latter appears to be the most probable opinion; and,,, if this be found to be the case, it may be equally beneficial to titillate the skin of the sound as of the paralytic limb, thus obtaining a more extensive, and a more elficacious, mode of applying titillat-ioi* as a remedy. The influence of mental emotion on the nervous system, and on the vital and animal functions, has not yet met with that consideration in the treatment of diseases which it appears to merit. The effects of music in some of these diseases, and the' variations of the same disease in individuals, under the influence of different mental emotions, prove this influence, and might lead us to expect that great beneficial advantages might be derived, from acting on the minds of those afflicted with swell complaints.. We have to apologize for the delay which has occurred in our account of this publication, which unquestionably merited an earlier notice. In one respect our neglect may be advantageous. The last edition of the London Pharmacopoeia has incurred much criticism, and in our opinion the objections that have been urged, not having been regarded in the proper quarter, ought to be revived. When the new edition w^as announced, the great note of preparation, the issuesof a specimen primum et alteram, previous to the appearance of the magnum opus; the improved state of Chemical science ; the recent publications of the colleges of Edinburgh and of Dublin j ail combined to raise anticipation of the London edition to a high pitch. In a work of this nature it were Tain to expect any thing like perfection, the art of chemistry v is still progressive, and we must admit that the new editionof Mr. Phillips on the Phannacopeeia Londinensis. '227 of the London Pharmacopoeia, considering the immense distance the former one was behind the present state of the art, has made a very successful attempt at overtaking it. Still the work is extremely incomplete; and, unfortunately for the reputation of the college, much of the imperfection might have been avoided. The fellows, indeed, did invite the licentiates to contribute their remarks on the occasion, and in some instances adopted the suggestions that were furnished by this degraded class of the profession. But we did tiot hear that any of the licentiates who had devoted themselves more especially to chemical pursuits, were invited to co-operate with the committee appointed by the college for conducting the experiments, and preparing the new Pharmacopoeia; neither could we learn that any professors of chemistry, practical chemists, or men of science, with or without degrees, "were consulted, although it is well known that the names of our first chemists are not recorded in the college list.
The natural consequence of this proceeding was immediately exposed by Dr. Bostock and other writers; amongst whom none is more conspicuous than Mr. Phillips, who lias followed the committee in most of their experiments and preparations. We doubt not that, had this gentleman been properly applied to in the first instance, much of the confusion and error which now render the Pharmacopoeia a dangerous guide, would have been obviated. It is hardly credible that, notwithstanding the practical errors committed in the directions for preparing some of the compounds, the absurdities in the nomenclature, the improper retention of some articles, and the undue rejection of others, with the frivolous change in the power of certain medicines, have been forced upon the attention of the college from various quarters, the Pharmacopoeia is still permitted to disgrace that learned body, and to produce perplexity and mischief in practice. A new edition was urgently demanded, and the frrst, however handsomely and expensively printed, ought to have been called in; even now it is not too late ; for many practitioners, deceived and disappointed by some of the new processes and preparations, ?have yet recourse to the old Pharmacopoeia.
Having offered these general remarks, not from any ill -spirit, but with the sincere desire that the college might yet retain its high station in public'opinion, and prevent any further ill consequences from the officinal preparations being made according to its directions \ it becomes us to support pur cage by facts, of which the work belore us presents a ^sufficient quantity: we shall content ourselves with citing only a few. In the very commencement of the work it is H h 2 curious SQS ' Critical Analysis, curious to observe the college violate its own rules. Thus octanus ,is given us as a :}e\v term to express a pint by sneasure, while the old term libra is intended to denote a pound by weight; but, as some fluids are weighed, in the ftrst instance (viz. the 4th process,) that this occurred in the Pharmacopoeia, libra was preceded by the word pondere; yet, in the same process, stlibra also occurs applied to a fluid, and the operator is left to guess whether that fluid is to be weighed or measured. Many other instances of this sort of inaccuracy are enumerated by Mr. Phillips.
In the preparation of the acids several errors of consequence appear. The alteration of strength in the diluted sulphuric and nitric acids, though trifling in itself, is yet perplexing to the practitioner, who may not be aware of the change, and certainly was needless.
Among the alkaline preparations, after noticing some most unfortunate blunders and inconsistencies, Mr, Phillips ob* serves, " Liquor ammonia; is now directed to be used in many of those preparations in which the subcarbonate was formerly employed; and it is particularly requisite that the attention of practitioners should be directed to this circumstance. I have already noticed the great difference which exists between the strength of the former aqua ammonia: purae and the present liquor ammoniac; the power of the liniinentum ammonia? fortius, and of the linhnentum camphor? compositum, has also been greatly increased. It  ?29 *' Iii the Pharmacopeia of 17S7, spirit of ammonia was prepared by adding three pints of proof spirit to a mixture of four ouuces of .muriate of ammonia, and six of impure subcarbonate of potash; one half of the spirit, being distilled, constituted the spirit of ami anonia: and the compound, or aromatic spirit was prepared by adding oils of lemons and cloves to a portion of this product. These processes are both objectionable; for, three parts of subcarbonate of potash not. being sufficient to decompose two of muriate of ammonia, a part of the latter salt must be wasted; the loss ol spirit is however still more considerable. Proof spirit is composed ot about 1.9 parts of rectified spirit and 13 parts of water ; three pints consequently contain about 28 fluid ouuces of the former, of which 21 only were directed to be distilled. The compound spirit was not only colored, but frequently turbid, owing to the usual impurity of the oils' of lemons and cloves. The modes of preparing these medicines have now undergone considerable alteration, and the new processes .derive from novelty their only merit, and from mischief their sole importance.
-" The following are the directions for preparing the Spiritus Ammonia : Take of rectified spirits, two pints; solution of ammonia*, a pint. Mix, " The Spiritus Ammoniac Aromaticus is prepared by adding a iluidrachm of oil of k'mons and oil of cloves to a pint of the simple spirit. " Pr. Powell asserts, th&t f alkohol dissolves ammonia, but not its carbonate; water dissolves both; and it is further intended, that the present spirit shall be of sufficient concentration to dissolve certain volatile oils in a subsequent preparation. The former preparation,' he continues, < appeared very uncertain as to strength, and a Jarge portion of carbonate of ammonia sublimed over which w as not dissolved ; the object of the present change has therefore been to obtain a more definite article than the former.' " Now the first of the above-quoted allegations is proved to be erroneous by a very simple experiment. I have stated that, in the former preparations, only 24 of 28 parts of the rectified spirits directed to be used, are obtained by distillation, the product must therefore be considered as very highly rectified spirits; and yet, if some of it be added to a solution of muriate of lime, a copious pre* cipitate of carbonate of lime ensues. " Neither have I observed that the former preparation was at all uncertain in its strength; but, on the contrary, the results of my experiments coincided to prove a very sufficient degree of uniformity in this respect, as 1 shall presently more particularly shew; whereas the present process has, in addition to its other faults, that of uncertain power in an eminent degree. Under the head of Liquor Ammonia, I have stated, that I found its sp. gr. to be *90-*, whilst that from Apothecaries' Hall had a sp. gr. of \988, and the power of the first of these preparations is nearly five times as great a? that of the latter; consequently, the aromatic spirits of ammonia, prepare with solutions varying as these, will differ equally in power. " In order to compare the strength of the new and the former preparation, I again made the liquor ammonias, but its sp. gr. instead of being as before *904, was *914, and it was consequently weaker than that which had been previously obtained. With this I made the spiritus ammonia; aromaticus as now directed, and added a fluid ounce of' it to a portion* of muriatic acid, which previous experiments had shewn to be capable of decomposing 240 grains of marble; the solution was strongly acid, and I therefore added some pieces of marble to it, having first noted their weight. After heatin'* the solution to ebullition for a considerable time, it appeared, on drying the undecomposed marble, that 145.grains had been dissolved ; consequently the saturating power of a fluid ounce of the spiritus ammonia; aromaticus is equal to that of 95 grains of marble. 'Phis experiment w^s repeated with scarcely any variation.
" I now treated the spiritus ammonias compositus of the late Pharmacopoeia in a similar way, and the mean of two experiments,, which varied but little, shewed that its saturating power was only